<head><title>FORMULIR PENDAFTARAN </title></head>
<body>
<FORM ACTION="durman1.php" METHOD="GET" NAME="input">
<center><h3><b><blink>FORMULIR PENDAFTARAN MAHASISWA UMK</blink></b></h3></center>
A. Nama Lengkap : <input type="text" name="nama"><br>
B. Tempat Dan Tanggal Lahir :
<select name="Tempat">
<option value="Kota"> Kota</option>
<option value="Kolaka"> Kolaka</option>
<option value="Kendari"> Kendari</option>
<option value="Konawe utara">Konawe utara</option>
<option value="Konawe selatan">Konawe selatan </option>
<option value="Raha">Raha</option>
<option value="Bau-bau">Bau-bau</option>
<option value="Wawonii">wawonii</option>
</select>
<select name="Tanggal">
<option value="Tgl"> Tgl</option><option value="01"> 01</option>
<option value="02"> 02</option><option value="03">03</option>
<option value="04">04 </option><option value="05">05</option>
<option value="06">06</option><option value="07">07</option>
<option value="08"> 08</option><option value="09"> 09</option>
<option value="10"> 10</option><option value="11"> 11</option>
<option value="12"> 12</option><option value="13"> 13</option>
<option value="14"> 14</option><option value="15"> 15</option>
<option value="16"> 16</option><option value="17"> 17</option>
<option value="18"> 18</option><option value="19"> 19</option>
<option value="20"> 20</option><option value="21"> 21</option>
<option value="22"> 22</option><option value="23"> 23</option>
<option value="24"> 24</option><option value="25"> 25</option>
<option value="26"> 26</option><option value="27"> 27</option>
<option value="28"> 28</option><option value="29"> 29</option>
<option value="30"> 30</option><option value="31"> 31</option>
</select>
<select name="Bulan">
<option value="Bln">Bln </option><option value="Januari"> Januari</option>
<option value="Februari"> Februari</option><option value="Maret">Maret</option>
<option value="april">april </option><option value="Mei">Mei</option>
<option value="Juni">Juni</option><option value="Juli">Juli</option>
<option value="Agustus"> Agustus</option><option value="September"> September</option>
<option value="Oktober"> Oktober</option><option value="November"> November</option>
<option value="Desember"> Desember</option>
</select>
<select name="Tahun"><option value="Thn"> Thn</option>
<option value="2012"> 2012</option><option value="2011"> 2011</option>
<option value="2010"> 2010</option><option value="2009"> 2009</option>
<option value="2008"> 2008</option><option value="2007"> 2007 </option>
<option value="2006"> 2006</option><option value="2005"> 2005</option>
<option value="2004"> 2004</option> <option value="2003"> 2003</option>
<option value="2002"> 2002</option><option value="2001"> 2001</option>
<option value="2000"> 2000</option><option value="1999"> 1999</option>
<option value="1998"> 1998</option><option value="1997"> 1997</option>
<option value="1996"> 1996</option><option value="1995"> 1995</option>
<option value="1994"> 1994</option><option value="1993"> 1993</option>
<option value="1992"> 1992</option><option value="1991"> 1991</option>
<option value="1990"> 1990</option><option value="1989"> 1989</option>
<option value="1988"> 1988</option><option value="1987"> 1987</option>
<option value="1986"> 1986</option><option value="1985"> 1985</option>
<option value="1984"> 1984</option><option value="1983"> 1983</option>
<option value="1982"> 1982</option><option value="1981"> 1981</option>
<option value="1980"> 1980</option>
</select><Br>
C. Agama : <br>
<input type="radio" name="Agama" value="Islam">Islam<br>
<input type="radio" name="Agama" value="Kristen">Kristen<br>
<input type="radio" name="Agama" value="Hindu">Hindu<br>
<input type="radio" name="Agama" value=Buda">Buda<br>
<input type="radio" name="Agama" value=Katolik">Katolik<br>
D. Jenis Kelamin :
<input type="radio" name="Jenis" value="Laki-laki">Laki-laki
<input type="radio" name="Jenis" value="Perempuan">Perempuan<br>
E. Mata Kuliah yang diminati : <BR>
<input type="checkbox" name="Mata_Kuliah01" value="Open Source">Open Source<br>
<input type="checkbox" name="Mata_Kuliah02" value="Jaringan Komputer">Jaringan Komputer<br>
<input type="checkbox" name="Mata_Kuliah03" value="Pemograman WEB">Pemograman WEB<br>
<input type="checkbox" name="Mata_Kuliah04" value="Basis Data">Basis Data<br>
<input type="checkbox" name="Mata_Kuliah05" value="Pemrograman Hadwere">Pemrograman Hadwere<br>
<input type="checkbox" name="Mata_Kuliah06" value="Multimedia">Multimedia<br>
<input type="checkbox" name="Mata_Kuliah07" value="Pemrograman Lanjut">Pemrograman Lanjut<br>
<br>
<input type="submit" name="Input" value="pilih">
<input type="Reset" value="Reset" size="10%">
</FORM>
</body>
</html>
<?php
if (isset($_GET['Input'])) {
$nama= $_GET['nama'];
echo "A. Nama Lengkap Anda :
<font color = red><b>$nama</b></font><br>";
$Tempat = $_GET['Tempat'];
echo "B. Tempat Dan Tanggal Lahir Anda Adalah :
<font color = red><b>$Tempat</b></font>";
$Tanggal = $_GET['Tanggal'];
echo " -
<font color = red><b>$Tanggal</b></font>";
$Bulan = $_GET['Bulan'];
echo " -
<font color = red><b>$Bulan</b></font>";
$Tahun = $_GET['Tahun'];
echo " -
<font color = red><b>$Tahun</b></font><BR>";
$Agama= $_GET['Agama'];
echo "C. Agama Anda adalah :
<font color = red><b>$Agama</b></font><br>";
$Jenis= $_GET['Jenis'];
echo "D .Jenis Kelamin Anda adalah :
<font color = red><b>$Jenis</b></font><br>";
echo " E.Mata Kuliah yang diminati: <br>";
if (isset($_GET['Mata_Kuliah01'])) {
echo "
<font color=blue></font>".$_GET['Mata_Kuliah01'] ."<br>";
}
if (isset($_GET['Mata_Kuliah02'])) {
echo "
<font color=blue>></font> " . $_GET['Mata_Kuliah02'] . "<br>";
}
if (isset($_GET['Mata_Kuliah03'])) {
echo "
<font color=blue>></font> " . $_GET['Mata_Kuliah03'] . "<br>";
}
if (isset($_GET['Mata_Kuliah04'])) {
echo "
<font color=blue>></font> " . $_GET['Mata_Kuliah04'] . "<br>";
}
if (isset($_GET['Mata_Kuliah05'])) {
echo "
<font color=blue>></font> " . $_GET['Mata_Kuliah05'] . "<br>";
}
if (isset($_GET['Mata_Kuliah06'])) {
echo "
<font color=blue>> </font>" . $_GET['Mata_Kuliah06'] . "<br>";
}
if (isset($_GET['Mata_Kuliah07'])) {
echo "
<font color=blue>> </font>" . $_GET['Mata_Kuliah07'] . "<br>";
echo "<h4>Maaf Anda Gagal Dalam Mengisi Formulir Silahkan Untuk Mengulangi Lagi</h4>";
} else {
echo "<h4>Selamat Anda Telah Mengisi Formulir Pendaftaran Dengan Baik</h4>";
}
}
?>
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